Total gastric necrosis subsequent to acute pancreatitis

Successful resolution of gastric perforation caused by a severe complication of pancreatic walled-off necrosis: A case report

BACKGROUND

Pancreatic walled-off necrosis (WON) rarely causes critical gastric necrosis and perforation, which may develop when pancreatic WON squashes against the stomach. The Atlanta 2012 guidelines were introduced for acute pancreatitis and its related clinical entities. However, there are few reported cases describing the clinical course and resolution of pancreatic WON.

CASE SUMMARY

We report the case of a 45-year-old man who presented to the urgent emergency department with gastric perforation caused by a severe complication of pancreatic WON on computed tomography. The patient underwent an emergency distal pancreatectomy, splenectomy, and gastric wedge resection. Postoperative findings showed re-perforation of the gastric wall at a previously resected margin. Furthermore, endoscopic examination revealed an ulcerative area with a defect in the fundus. After diagnostic endoscopy, endoscopic vacuum-assisted closure was performed, and continuous suction was transferred over all tissues in contact with the sponge surface. The patient recovered without any further complications and was discharged in good condition at postoperative week 8. No recurrence occurred during the 6-mo follow-up period.

CONCLUSION

When managing a patient with serious gastric perforation complicated by pancreatic WON, a multidisciplinary treatment approach should be considered.

Gastric perforation and renal vein thrombosis in acute pancreatitis: a case report

Background

Acute pancreatitis is one of the most common causes of acute abdomen. It is associated with multiple complications. Gastric perforation and isolated renal vein thrombosis are two infrequent complications. We present a case of acute pancreatitis with gastric perforation and isolated renal vein thrombosis in the same patient.

Case presentation

A 28-year-old gentleman with chronic alcohol intake presented with complaints of abdominal pain and not responding to analgesics. Biochemical investigations revealed elevated amylase and lipase level. Contrast-enhanced computed tomography (CECT) showed necrotizing pancreatitis with necrotic collection in the lesser sac. On oral contrast, active contrast extravasation from gastric perforation was picked up. Renal vein and splenic vein thrombosis was observed.

Conclusions

Gastric perforation and renal vein thrombosis are two infrequent complications of acute pancreatitis. High-end radiological suspicion is needed to reduce the associated morbidity and mortality.

Total gastric necrosis following acute pancreatitis in a patient with COVID -19: Case report and literature review

The Coronavirus Disease Pandemic - 2019 (COVID-19) has spread to more than 200 countries worldwide, affecting more than 2 million people and >120,000 deaths, Acute pancreatitis of infectious origin can be caused by different viruses but currently no study has concluded that COVID-19 is directly responsible for acute pancreatitis. We report the case of a COVID-19 patient admitted to the emergency room in a state of respiratory distress associated with stage E pancreatitis according to the classification of balthazar whose surgical exploration found total necrosis of the stomach. A total gastrectomy was performed with an esophagostomy and a wide drainage of the abdominal cavity, the postoperative sequelae were marked by the death of the patient at D6 postoperatively by cardiorespiratory arrest.

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The Coronavirus Disease Pandemic - 2019 (COVID-19) has spread to more than 200 countries worldwide, affecting more than 2 million people and >120,000 deaths.

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Acute pancreatitis of infectious origin can be caused by different viruses but currently no study has concluded that COVID-19 is directly responsible for acute pancreatitis.

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We report the case of a COVID-19 patient with stage E pancreatitis whose surgical exploration found total necrosis of the stomach.

Ischemic Gastritis: A Multicenter Case Series of a Rare Clinical Entity and a Review of the Literature

GOALS

To report a case series of ischemic gastritis and discuss its etiology, management, and associated mortality according to our results and the published English literature.

BACKGROUND

Ischemic gastritis is rare, given the rich blood supply of the stomach. It has been reported in isolated case reports and small case series. Most cases are vascular in origin and associated with a high mortality.

STUDY

Pathology databases from 3 hospitals affiliated with the University of Minnesota Medical School were searched for cases of ischemic gastritis in the last 10 years. Patients' demographics, clinical course, and 1-month and 1-year mortalities were collected from electronic medical records.

RESULTS

A total of 12 patients were identified (age range, 32.1 to 83.2), the largest series reported to date. The presenting symptom was gastrointestinal bleeding (8), abdominal pain (2), nausea (1), and symptomatic anemia (1). The etiology included postinterventional radiology embolization (2), hemodynamic changes in the setting of celiac axis stenosis (2), vasculitis (1), systemic hypotension (1), and unknown (6). Treatment included steroid therapy, revascularization by interventional radiology, surgery, or supportive treatment. Thirty-day and 1-year mortalities were 33% and 41%, respectively.

CONCLUSIONS

Ischemic gastritis is rare, but associated with a high mortality. Evaluation for treatable etiologies should be sought and corrected if present.